TeleDiet study: A randomised controlled study investigating the impact of smartphone-supported dietary education and counselling on secondary prevention of coronary heart disease

Abstract

Introduction: Dietary habits are a key factor influencing cardiovascular risk and its progression. Dietary counselling as part of current cardiac rehabilitation programmes has certain limitations: it is often intermittent with a delay between feedback on nutritional intake and reassessment by the dieticians. Digital technology could offer a solution. Purpose: The purpose of this study was to investigate the impact of smartphone‐supported feedback on dietary pattern and outcomes in a population with coronary heart disease (CHD). Methods: Of 129 successive patients with CHD, 16 patients who agreed to participate in the study were randomised to either a TeleDiet group or a control group. Patients in the TeleDiet group participated in smartphone‐supported diet education in addition to usual in‐person education by dietitians. The patients were asked to take pictures of their meals and send them to dietitians using a messaging application. The dietitians then sent them feedback about their diet. The patients in the control group received the usual education only. The primary outcome was the change of Mediterranean Diet score (MedDiet score) between the two groups during three months. The secondary outcomes were the estimate of self‐efficacy, medication adherence, and heart‐related quality of life (the change of the General Self‐Efficacy Scale [GSES], the Identification of Medication Adherence Barriers Questionnaire [IMAB‐Q], and the HeartQoL). A total of 14 patients were included in the analysis. Results: As a whole, 113 patients did not participate in the study. The most common reason of rejection was “no interest in the study” and the second one was “unable to use a smartphone”. Table 1 showed the characteristics of the 14 patients separated into two groups: the TeleDiet group (n = 6) and the control group (n = 8). There was no difference of baseline characteristics between the two groups. The changes of the MedDiet score were not significantly different between the TeleDiet group and the control group (2.0 ± 4.5 vs. 1.3 ± 5.2, p = 0.783). In terms of the secondary outcomes, there were no significant differences between the two groups (Table 2). There were no significant differences of these outcomes in within‐group analysis, neither. Conclusion: Using a smartphone application is a hurdle for CHD patients at the moment, and these preliminary results do not show a benefit of dietary intervention with mobile health. These are the intermediate results of the whole TeleDiet study, and the study should be expanded to a larger population. (Table Presented).